Health
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In September a non-profit-making organisation called the Eden Alternative held its first UK training course in a unique system of caring for elderly people. Its methods have already transformed many care homes in Canada, Australia and the US, and are now beginning to take hold in homes in Japan, Germany, Denmark, Switzerland and Austria. If the philosophy is adopted here, the glum, institutional lifestyle currently experienced by most of the half-a-million occupants of Britain’s care homes may also be about to improve. The Eden Alternative came into being in 1992 after an American doctor, Bill Thomas, was called out to deal with an elderly nursing home resident’s skin rash. Dermatology, however, turned out to be but a side issue. “Doctor, I’m so lonely,” his patient whispered. The incident led Dr Thomas to reflect on the daily lives of care home residents and to conclude that the furnishings, the food and even the medical care were relatively unimportant. The real issues were loneliness, helplessness and boredom. Thomas devised the Eden Alternative to dispel these feelings by offering care home residents an ideal environment: his ambitious goal was to create for them something approaching a Garden of Eden. Dr Thomas believed that the key to achieving this lay in putting the residents centre-stage in care homes. It sounds obvious, but in most of Britain’s care homes it is the staff who dominate. Uniformed men and women ‘care’, while dependent, second-class citizens – the residents – fit into a régime imposed on them. The ritual of the drugs round, for example, stamps the authority of nurses on a home’s routine, as well as providing an unhelpfully regular reminder of illness and infirmity. The Eden approach banishes all this. Medicines are placed in day-by-day dispensers and administered by a new group of staff called “life assistants”. These are helpers with no uniform who act essentially as the residents’ best friends. Nurses keep an eye out for medical issues from the sidelines, focusing on preventative care, and monitoring everything from balance to the side-effects of medication, and coming in when necessary, rather than running the home like a hospital ward. Enhanced roleUnlike Britain’s care assistants, life assistants enjoy considerable status. Their job is no less than to enable people who are challenged by age, infirmity or illness to live as happy and fulfilling a life as possible. In keeping with this enhanced role, they are given far more training than a care assistant. This goes beyond health and safety issues and how to help with washing and dressing to embrace the psychological aspects of care. Self-esteem, to which so much attention is paid in the case of the young, is often even more of an issue for elderly people. Many have been stripped of the things that normally provide social status – like a spouse, job or children – and then find themselves so frail or disabled that they are unable to look after their own day-to-day needs. If they then spend their time sitting mutely day after day, while somebody else attends to all their physical needs at times, and in ways, over which they have little control, it is hardly surprising that feelings of self-worth ebb away. The Eden philosophy assumes that the helplessness giving rise to this loss of self-esteem must be addressed, and that the key to achieving this is reciprocity. Those being cared for must also be enabled to give. Opportunities for this may arise simply through chatting. The Eden approach requires that the everyday details of life are constantly varied. This can prompt conversation, which can, in turn, lead people to share information. Christa Monkhouse is a Clinical Nurse Specialist in Elder Care. She helped to manage two Eden homes near Zurich and co-ordinates the dissemination of the Eden Alternative in the German-speaking parts of Europe, and told me: “Open a different jar of marmalade and people start talking about the old days. We can talk for hours about food. Inevitably, some of this will involve residents offering helpful suggestions.” Children are positively encouraged to come into Eden homes – the children of staff, children from a local town, as well as residents’ grandchildren. They provide interest and inspire meaningful activity. The residents are encouraged to tell the children stories, help them with reading or show them how to nurture plants, for example. But what meaningful activity is possible if you are 96 and have advanced dementia?
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